On reasonable truth-telling for unreasonable patients
The aim of this article is to explain to what extent the mechanisms of truth-telling diagnostics and other relevant information to the patients suffering from vascular dementia (VaD) must be adapted to the seven stages of evolution represented by the pathology of this disease. We argue in favor of preserving a deontological moral approach of truth-telling for the first three stages of VaD in order to shift to a consequentialist moral background of guiding the moral actions and communicative acts of speech with VaD patients in the last three stages of their disease. The middle stage, known as stage 4, appears to be the most problematic since empirical observations of the patient’s medical state are needed to shift from a deontological to a consequentialist approach at the first sign of the patients’ compromised autonomy. As we develop and critically expose pro and against deontological and consequentialist mechanisms of truth-telling to VaD patients, our arguments lead to a puzzle of moral beliefs that we engage in these two moral backgrounds. We argue that the shift of these two moral types of truth-telling mechanisms depending on the patient’s cognitive decline lies in the following assumptions: autonomy is a moral principle related to memory, and autonomy is regarded as a principle merely assigned to lucidity.